Give someone authorisation

Authorise someone to arrange your health care matters

Note: on the form, we ask the both of you for an official signature. Without them, we can unfortunately not accept authorisation (power of attorney).

My details

Find your BSN on your driving license or passport
Find it on your insurance card or policy document

I authorise

Fill in only if you are insured at Zilveren Kruis


Authorisation period

Please note! The authorisation is valid up to 5 years.




Please note! This form is only valid with both signatures. Yours and the person you authorise. Scan or take a digital picture of both signatures. Add that as an attachment. You can only upload .pdf, .jpg, of .png files.

You have not yet uploaded any files